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CompletedNCT04625504Updated Mar 27, 2023

Investigating Biological Targets, Markers, and Intervention for Chronic Pain

An interventional study of Mindfulness Based Intervention in Chronic Pain, Pain, Chronic and Pain Syndrome, sponsored by Vanderbilt University Medical Center. Completed at 1 site in United States. Open to participants aged 18 Years to 60 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-03-27.

Sponsored by Vanderbilt University Medical Center · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
69
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
All
01

Study summary

This multi-modal methods study will investigate neurophysiological, endocrinological, cognitive, psycho-social-emotional markers of chronic pain, and therapeutic targets using integrative health treatments.

Read the detailed description

It is estimated that 50 million adults in the USA suffer from chronic pain. Chronic pain is one of the most common reasons adults seek medical care, causing undue burden on primary care channels and treatment costs. Chronic pain is associated with (1) restrictions in mobility and daily activity, (2) dependence on opioids, (3) anxiety and depression, and (4) poor perceived health and reduced quality of life. Developing robust and specific non-pharmacologic intervention programs, on par with pharmacological clinical outcomes without harmful side-effects, addictive risk, and toxicity, is a crucial unmet clinical need and a research priority for the NCCIH. Understanding the mechanistic pathways of these interventions is key to their clinical development and implementation for treating chronic pain in primary care.

Mindfulness-Based Interventions (MBIs) show similar clinical efficacy for mood disorders as pharmacology, and co-morbid symptoms of depression and anxiety. Meta-analysis including 183 patients with Multiple Sclerosis showed efficacy in psychosocial outcomes, quality of life, anxiety, depression, and select physical symptoms including fatigue, pain, and vestibular symptoms. The clinical efficacy of MBIs appears to extend mood disorders, as a systematic review including 13 studies in fibromyalgia, chronic fatigue, and irritable bowel syndrome showed significant effect sizes, reported as standardized mean difference (SMD), compared to control conditions in reducing symptom severity (SMD= -.40), and pain (SMD= -.21). Cognitively, MBIs appear to enhance executive control and self-regulatory processing, that has a beneficial effect upon emotion regulation, pain perception, and has shown to reduce ruminative ideation. Previous research has also suggested that mindfulness meditation training improves chronic pain symptomology through certain mechanisms such as disengagement from pain-related threats. While previous research has shown MBIs to be effective in treating certain health conditions, the mechanisms by which MBIs lead to clinical changes remain unclear. No study has adequately investigated biological or neurophysiological markers in chronic pain that may correlate with reduction in clinical symptoms.

This overarching study aims to identify key phenotypic markers and treatment targets of chronic pain, and further understand MBI mechanism in its treatment.

02

Conditions studied

  • Chronic Pain
  • Pain, Chronic
  • Pain Syndrome
  • Pain, Neuropathic
  • Pain, Intractable

Keywords

  • Neurophysiology
  • Endocrine
  • EEG/ERP
  • Cognitive
  • Mindfulness
  • Mechanistic Clinical Trial
03

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion Criteria for Chronic Pain Patients:

  • Age range: 18-60 years
  • Must indicate pain intensity of 3/10 and must have experienced pain for at least 3 months
  • Must possess English language skills sufficient for providing informed consent, completing questionnaires, and understanding instructions
  • Must have a stable medication regimen or no medication or dosage changes within the past month

Blood Collection Inclusion:

  • At least 110 pounds
  • Generally healthy by self-report on day of collection (i.e., free of cold and flu symptoms on the day of collection, no infections within two weeks prior to collection, no known sickle cell disease)
  • Including the study draw, blood donation for clinical or research purposes within the preceding eight weeks will not exceed 550 mL
  • No more than one blood draw will have occurred during the preceding week

Exclusion Criteria for Chronic Pain Patients:

  • Prior diagnosis of bipolar I, bipolar II, psychotic personality disorder, borderline personality disorder, and/or narcissistic personality disorder
  • Current history (equal/less than 6 months) of substance abuse/dependence
  • Current history (equal/less than 6 months) of regular meditation practice (>1 session/week; >10 min/session)
  • Diagnosis of bipolar I, bipolar II, psychotic personality disorder, borderline personality disorder, and/or narcissistic personality disorder
  • History of medical illness associated with possible changes in cerebral tissue or cerebrovasculature (e.g., stroke) or with neurologic abnormality (e.g., seizure disorder, cerebrovascular or neoplastic lesion, neurodegenerative disorder, or significant head trauma, defined by loss of consciousness of ≥ 5 minutes)
  • Current suicidal ideation

Exclusion Criteria for Healthy Controls:

  • Current history (equal/less than 6 months) of substance abuse/dependence
  • No major medical illness. History of medical illness associated with possible changes in cerebral tissue or cerebrovasculature (e.g., stroke) or with neurologic abnormality (e.g., seizure disorder, cerebrovascular or neoplastic lesion, neurodegenerative disorder, or significant head trauma, defined by loss of consciousness of ≥ 5 minutes)
  • Current suicidal ideation
  • Current history (equal/less than 6 months) of regular meditation practice (>1 session/week; >10 min/session)
04

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
69 participants (actual)

Study arms

  • Experimental
    Mindfulness Based Intervention (MBI)

    Patients Active Intervention group

    Behavioral: Mindfulness Based Intervention

  • No intervention
    Wait-list Control (WL)

    Patients Control receiving no treatment

  • No intervention
    Healthy Control (HC)

    Healthy Control receiving no treatment

Interventions

  • BehavioralMindfulness Based Intervention

    Standardized 8-week Cognitive and Behavioral Psychotherapy group with 26 hrs of in-class training and homework, along with 1 all-day retreat in which core mindfulness skills are developed

    Also known as: MBI

05

What researchers measure

Primary outcomes

  1. Electroencephalography (EEG)

    Oscillatory Activity

    Time frame: 36 months

  2. Electroencephalography (EEG)

    Event-Related Potentials (ERPs)

    Time frame: 36 months

Secondary outcomes

  1. Endocrine Measures

    Cortisol, Oxytocin

    Time frame: 36 months

  2. Cognitive-Behavioral Measure

    Executive Inhibitory Control

    Time frame: 36 months

  3. Cognitive-Behavioral Measure

    Working Memory

    Time frame: 36 months

Other outcomes

  1. Clinical: Pain Measure

    McGill Pain Questionnaire; Score range: 0 -- 45, with higher scores indicating worse outcomes.

    Time frame: 36 months

  2. Clinical: General Symptoms

    Patient Reported Outcomes Measurement Information System; Score range: 4 -- 20, with higher scores indicating worse outcomes

    Time frame: 36 months

  3. Clinical: Mindfulness Skills

    Five Facet Mindfulness Questionnaire; 5 domains, Score range: 0 -- 8, with higher scores indicating more mindfulness skills.

    Time frame: 36 months

  4. Clinical: Interoception

    Multidimensional Assessment of Interoceptive Awareness; 8 subdomains, Score range: 0 -- 5, with higher scores indicating more interoceptiveness

    Time frame: 36 months

06

Study locations

1 site
  • Vanderbilt University Medical Center
    Nashville, Tennessee 37203, United States
07

References and documents

Individual participant data

Plan to share: Yes — The PI will adhere to the NIH Sharing of Biomedical Research Resources: Guidelines for Recipients of NIH Grants and Contracts on Obtaining and Disseminating Biomedical Research Resources. 1. Quality-controlled raw data as well as processed data used in publications will be de-identified before sharing upon "reasonable request". As described in the proposal, workflows and structure will be exactly described in reports and documented to allow precisely reproduce results from raw data and replicate methodology. Final data (computerized datasets with raw data and derived variables) that have not yet been published will be shared in a timely manner. 2. Software programs (i.e. experimental paradigm scripts produced for this study) and documentation will be made available for research purposes to replicate findings upon "reasonable request", and any software/script sharing requirements by journals.

Supporting information: Csr

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT04625504
Lead sponsor
Vanderbilt University Medical Center
Responsible party
Poppy Schoenberg (Principle Investigator, Vanderbilt University Medical Center) — Principal investigator
First posted
Nov 12, 2020
Start date
Nov 25, 2020
Primary completion
Jul 28, 2022
Completion
Jul 28, 2022
Last update
Mar 27, 2023

Study contacts

Poppy LA Schoenberg, PhD
principal investigator · Vanderbilt University Medical Center

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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